HomeMy WebLinkAboutdrain layer permit 59 Saginaw Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
South Windsor, Connecticut
List.No.:
DRAIN LAYER'S PERMIT N? 1663
Pursuant to written applicatior, permission is hereby, granted t the Licensed Drain Layer.named herein to perform
the work indicated below at/ 1 on the
X1�n..�fti. side, between'
r
at premises owned by
whose address is9
and to Lay House Drain, Repair___House Drain, Lay Main, Other
for � A Q occupancy or use,
with 0 Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE INDUSTRIAL WASTES ( , OR ( )
Connection will be made with `"I
Permit to be issued to iza f1-411.4
the holder of Drain Layer's License No. Permit will expire on 19
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the permit and the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
Signed
Connection Charge Paid — Licensed Drain Layer
- ,LLd�6�Z22 Issued by �
Tax Collector
�U
Permit Fee:. Paid $
INSPECTION: Check Number: ,-2Q �-3—
INITIAL (Sig)
FINAL (Sig)
APPROVED Z (Date)
` (Sig)
INSPECTOR
�� ys8�N4s 277
— _�. 45 13�NQ
l�►vrJ p� $.5-1 ti/Y�F
FOviv PAT+oN CLE-At l t,7-
Ho, 5`1
< J
NOTES SOUTH WINDSOR POLLUTION CONTROL
w 4T,6f2 T.E.S 7- - LOCATION T SA G(IQA K-) ST"
OWNER
TYPE OF WORKAl
DATE - 2 I - PERMIT PIPE
INSTALLER
INSPECTOR 7J Z- DRAWN BY �L-